Medications

Individual responses to medications vary greatly. Target the triggers of nausea/vomiting
such as motion sensitivity, while ensuring adequate hydration and metabolic balance. If a woman is vomiting constantly, oral dosing of
medications will likely be ineffective.

SEROTONIN ANTAGONISTS

More common side-effects: Headache, mild liver function abnormalities,
constipation*, diarrhea* Proactive, daily bowel management is very important. For information on managing these symptoms, see this article on MedicineNet.

Often effective in mothers who have multiple
triggers (smell, motion, etc.), a history of hormone sensitivity,
and/or moderate to severe vomiting. If a woman has a history
of HG that responded to serotonin antagonists, it should be
considered as a first line drug to minimize symptom severity.

IMPORTANT: Effects are dose dependent.
Best taken on a strict schedule and weaned very
slowly when asymptomatic for two weeks. May be needed until delivery.

Typical protocol (prevention of vomiting due to chemotherapy) includes combining with a serotonin antagonists and steroids.

None for HG yet.

CORTICOSTEROIDS

Cortisone/Corticosteroids - Not recommended until after 8-10 weeks
- Used for refractory hyperemesis
gravidarum, usually in conjunction with ondansetron
- Possible side-effects: blood sugar instability, weight loss, nausea and vomiting, increased risk of
preeclampsia
- Possible fetal complications: reduced birth weight, clefts (if early use), adrenal insufficiency (if exposed to large doses)
-
Inconclusive
concerns over impact on fetal brain development and oral/lip clefts
with prolonged dosing at high levels, and use during the first
trimester.(Collaborative Perinatal Project)
- Typical treatment is a steroid burst with a rapid taper similar to what is used in
acute asthma attacks. [Most studies
of asthma patients using steroids show no adverse fetal effects.]
-
Hypothyroid mothers may have an
exaggerated response to corticosteroids
- Diabetic mothersmay require as much as a 40% increase in their insulin
when high dose steroids are started.

PROKINETIC AGENTS

Reglan blocks dopamine receptors in the CTZ (chemoreceptor trigger
zone) and increases the CTZ threshold & decreases the sensitivity
of visceral nerves that transmit afferent impulses from the GI
tract to the vomiting center.

- Helpful in women who vomit after eating/drinking, and who do not respond
to Zofran alone.
- Sometimes
used in conjunction with meds such as Zofran.
-
Use with antihistamines
to minimize side-effects.
-
Side-effects are very common and can be severe, especially when given quickly through an IV.

Category A
Adequate and well-controlled studies have failed to demonstrate
a risk to the fetus in the first trimester of pregnancy (and
there is no evidence of risk in later trimesters).

Category B
Animal reproduction studies have failed to demonstrate a risk
to the fetus and there are no adequate and well-controlled
studies in pregnant women.

Category C
Animal reproduction studies have shown an adverse effect on the
fetus and there are no adequate and well-controlled studies
in humans, but potential benefits may warrant use of the drug
in pregnant women despite potential risks.

Category D
There is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience
or studies in humans, but potential benefits may warrant use
of the drug in pregnant women despite potential risks.

Category X
Studies in animals or humans have demonstrated fetal abnormalities
and/or there is positive evidence of human fetal risk based
on adverse reaction data from investigational or marketing
experience, and the risks involved in use of the drug in pregnant
women clearly outweigh potential benefits.